| NPI | 1376158774 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY L. BRADLEY Family Nurse Practitioner 888-984-7277 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| 261QP2300X Clinic/Center, Primary Care | |
| 261QU0200X Clinic/Center, Urgent Care | |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2023-12-30 |